Variation in Anesthesiology Provider-Volume for Complex Gastrointestinal Cancer Surgery A Population-Based Study

被引：1

作者：

Hallet, Julie ^{[1
,2
,3
,4
]}

Sutradhar, Rinku ^{[4
]}

Eskander, Antoine ^{[3
,4
,5
]}

Carrier, Francois M. ^{[6
,7
]}

Mcisaac, Daniel ^{[4
,8
,9
]}

Turgeon, Alexis F. ^{[10
,11
]}

d'Empaire, Pablo Perez ^{[12
,13
]}

Idestrup, Chris ^{[12
,13
]}

Flexman, Alana ^{[14
]}

Lorello, Gianni ^{[13
,15
,16
,17
]}

Darling, Gail ^{[1
,18
]}

Kidane, Biniam ^{[19
,20
]}

Chan, Wing C. ^{[20
]}

Kaliwal, Yosuf ^{[4
]}

Barabash, Victoria ^{[3
]}

Coburn, Natalie ^{[1
,2
,3
,4
]}

Jerath, Angela ^{[3
,4
,12
,13
]}

机构：

[1] Univ Toronto, Dept Surg, Toronto, ON, Canada

[2] Sunnybrook Hlth Sci Ctr, Div Gen Surg, Toronto, ON, Canada

[3] Sunnybrook Res Inst, Clin Evaluat Sci, Toronto, ON, Canada

[4] ICES, Toronto, ON, Canada

[5] Univ Toronto, Dept Otolaryngol Head & Neck Surg, Toronto, ON, Canada

[6] Ctr Hosp Univ Montreal, Ctr rech CHUM, Carrefour innovat & sante populat, Div Crit Care,Dept Anesthesiol, Montreal, PQ, Canada

[7] Univ Montreal, Dept Anesthesiol & Pain Med, Montreal, PQ, Canada

[8] Univ Ottawa, Dept Anesthesiol & Pain Med, Ottawa, ON, Canada

[9] Ottawa Hosp, Ottawa, ON, Canada

[10] Univ Laval, Dept Anesthesiol & Crit Care, Div Crit Care Med, Quebec City, PQ, Canada

[11] Univ Laval, Trauma Emergency Crit Care Med, Populat Hlth & Optimal Hlth Practices Res Unit, CHU Quebec Univ Laval Res Ctr, Quebec City, PQ, Canada

[12] Sunnybrook Hlth Sci Ctr, Dept Anesthesiol, Toronto, ON, Canada

[13] Univ Toronto, Dept Anesthesiol & Pain Med, Toronto, ON, Canada

[14] Univ British Columbia, Dept Anesthesiol Pharmacol & Therapeut, Vancouver, BC, Canada

[15] Toronto Western Hosp, Dept Anesthesiol, Toronto, ON, Canada

[16] Univ Hlth Network, Toronto Western Hosp, Wilson Ctr, Toronto, ON, Canada

[17] Womens Coll Hosp, Womens Coll Res Inst, Toronto, ON, Canada

[18] Univ Hlth Network, Dept Surg, Div Thorac Surg, Toronto, ON, Canada

[19] Univ Manitoba, Dept Surg, Sect Thorac Surg, Winnipeg, MB, Canada

[20] Univ Manitoba, Dept Community Hlth Sci, Winnipeg, MB, Canada

来源：

ANNALS OF SURGERY | 2023年 / 278卷 / 04期

关键词：

anesthesiology; outcomes; surgery; variation; volume; HOSPITAL VOLUME; SURGERY; MORTALITY; IMPACT; ASSOCIATION; QUALITY; REGIONALIZATION; COMPLICATIONS; SUBSPECIALTY; SURVIVAL;

D O I：

10.1097/SLA.0000000000005811

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: Examine between-hospital and between-anesthesiologist variation in anesthesiology provider-volume (PV) and delivery of high-volume anesthesiology care.Background: Better outcomes for anesthesiologists with higher PV of complex gastrointestinal cancer surgery have been reported. The factors linking anesthesiology practice and organization to volume are unknown.Methods: We identified patients undergoing elective esophagectomy, hepatectomy, and pancreatectomy using linked administrative health data sets (2007-2018). Anesthesiology PV was the annual number of procedures done by the primary anesthesiologist in the 2 years before the index surgery. High-volume anesthesiology was PV>6 procedures/year. Funnel plots to described variation in anesthesiology PV and delivery of high-volume care. Hierarchical regression models examined between-anesthesiologist and between-hospital variation in delivery of high-volume care use with variance partition coefficients (VPCs) and median odds ratios (MORs).Results: Among 7893 patients cared for at 17 hospitals, funnel plots showed variation in anesthesiology PV (median ranging from 1.5, interquartile range: 1-2 to 11.5, interquartile range: 8-16) and delivery of HV care (ranging from 0% to 87%) across hospitals. After adjustment, 32% (VPC 0.32) and 16% (VPC: 0.16) of the variation were attributable to between-anesthesiologist and between-hospital differences, respectively. This translated to an anesthesiologist MOR of 4.81 (95% CI, 3.27-10.3) and hospital MOR of 3.04 (95% CI, 2.14-7.77).Conclusions: Substantial variation in anesthesiology PV and delivery of high-volume anesthesiology care existed across hospitals. The anesthesiologist and the hospital were key determinants of the variation in high-volume anesthesiology care delivery. This suggests that targeting anesthesiology structures of care could reduce variation and improve delivery of high-volume anesthesiology care.

引用

页码：E820 / E826

页数：7

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